Setting aside cases complicated by fracture on the one hand and by nervous lesion on the other, sprains may be, for purposes of treatment, divided into two classes - those with swelling and those without, the latter being a very small minority, which is practically limited to sprains about joints and amongst the deep muscles of the back and neck.

Sprains without swelling (formerly called 'Strains'). Here the main immediate indication is the relief of pain, which in these cases is frequently intense. Rest of the part, combined with very firm compression of the region immediately concerned, is usually effectual in this respect if the pressure is of the right kind; and I know of no means of applying effectual pressure excepting strapping, which should, if obtainable, be to a certain extent resilient, like, for example, the wash-leather strapping made by Messrs. Ewen & Son, which is ideal for this purpose. It is, however, perhaps too expensive for ordinary use, the best alternative being Leucoplast, which, although made in Germany, is in my experience so far superior to the English varieties of the same thing that my patriotism does not prevent my using it. (It should be borne in mind that the real object of the use of strapping in these cases is to give support, and hence rest, to the part; its proper application is therefore a matter of some moment, especially in parts constantly moving, like, for instance, the chest wall. In sprain of one side of the chest the strapping should, of course, be made to include at least two-thirds of the circumference of the thorax, passing well beyond the middle line in front and behind, the application of each strip being made quickly at the end of a complete expiratory effort. An apology is needful for these elementary details, but my experience shows that some little facts of this kind are not familiar to us all.) The immediate pain having been thus relieved, massage cannot commence too soon; but passive movement in these cases is better deferred for six or seven days, as secondary swelling is apt to follow its use if employed too soon. Voluntary movements by the patient may. however, be allowed from the first, the extent of these movements being determined by the amount of pain: as a matter of fact, in many of these cases, as well as in some other varieties of sprain, voluntary movements by the patient are frequently a source of immediate comfort.